Cardiovascular disorders: assessing fitness to drive

Question

Accepted Answer

✘- Must not drive

! - May continue to drive subject to medical advice and/or notifying DVLA

✓- May continue to drive and need not notify DVLA

Angina - to include INOCA (ischaemia with non-obstructive arteries)

	Group 1 car and motorcycle	Group 2 bus and lorry
Angina	✘- Must not drive when symptoms occur: ■ at rest ■ with emotion ■ at the wheel. Driving may resume after satisfactory symptom control. Need not notify DVLA.	✘- Must notify DVLA. Must not drive when symptoms occur A licence will be refused or revoked if symptoms continue (treated or untreated). May be relicensed/licensed (provided there is no other disqualifying condition) if: ■ no angina for at least 6 weeks ■ the requirements for exercise or other functional tests can be met (see Appendix C)

Acute coronary syndrome (ACS) - to include type 1 and type 2 myocardial infarction, MINOCA (myocardial infarction with non-obstructive coronary arteries) and Takotsubo cardiomyopathy

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - Must not drive but need not notify DVLA. Driving may resume 1 week after ACS if successful coronary intervention (PCI) has been carried out and if all of the following are met: ■ no other urgent revascularisation planned (urgent means within 4 weeks of acute event) ■ LV ejection fraction is at least 40% before hospital discharge ■ there is no other disqualifying condition If not treated by successful coronary intervention or any of the above are not met, driving may resume only after 4 weeks from the acute event, provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA – for all ACS. Licence will be refused or revoked. May be relicensed/licensed after at least 6 weeks if: ■ LV ejection fraction is at least 40% ■ the requirements for exercise or other functional tests can be met (see Appendix C) ■ there is no other disqualifying condition No functional cardiac test is required in Takotsubo cardiomyopathy in the absence of known coronary artery disease

Elective percutaneous coronary intervention (PCI)

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive for at least 1 week but need not notify DVLA. Driving may resume after 1 week provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after at least 6 weeks if: ■ LV ejection fraction is at least 40% ■ the requirements for exercise or other functional tests can be met (see Appendix C) ■ there is no other disqualifying condition

Coronary artery bypass graft (CABG)

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive for at least 4 weeks but need not notify DVLA. Driving may resume after 4 weeks provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after 3 months if: ■ LV ejection fraction is at least 40% ■ the requirements for exercise or other functional tests can be met (see Appendix C), at least 3 months postoperatively ■ there is no other disqualifying condition

Coronary artery disease

For Group 2 licensing, if there is evidence of obstructive coronary artery disease on invasive or CT angiography or myocardial ischaemia on functional testing but it does not fall under any of the categories above, those individuals would need to meet the functional test requirements.

Spontaneous coronary artery dissection (SCAD)

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - Must not drive but need not notify DVLA. Driving may resume 4 weeks after recovery from the acute event, provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused/revoked. Relicensing will be considered upon individual assessment.

Arrhythmias

Arrhythmias include:

sinoatrial disease
significant atrioventricular conduction defect
atrial flutter/fibrillation
narrow or broad complex tachycardia

Note:

if a transient arrhythmia occurs during an acute coronary syndrome, the guidance relating to ACS takes precedence
pacemakers are considered separately.

	Group 1 car and motorcycle	Group 2 bus and lorry
Arrhythmia	✘- Must not drive if arrhythmia has caused or is likely to cause incapacity. Driving may resume without DVLA notification only after: ■ underlying cause has been identified ■ arrhythmia is controlled for at least 4 weeks Must notify DVLA if there are symptoms that are likely to cause incapacity and/or the arrhythmia is not controlled for at least 4 weeks, and an underlying cause has not been identified. For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.	✘- Must notify DVLA. Must not drive if arrhythmia has caused or is likely to cause incapacity. Licence will be refused or revoked. May be relicensed/licensed (provided there is no other disqualifying condition) only after: ■ underlying cause has been identified ■ arrhythmia has been controlled for at least 3 months ■ LV ejection fraction is at least 40% For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Successful catheter ablation

	Group 1 car and motorcycle	Group 2 bus and lorry
For VT ablation with impaired ventricular function (right or left) or congenital heart disease (corrected or not)	✘- Must not drive for at least 4 weeks but need not notify DVLA. Driving may resume after 4 weeks provided there is no other disqualifying condition and arrhythmia has been controlled.	✘- Must not drive and must notify DVLA. May be relicensed/licensed (provided there is no other disqualifying condition) only after arrhythmia has been controlled for at least 3 months and LVEF at least 40%.
For other ablations	✘- Must not drive for at least 2 days but need not notify DVLA. Driving may resume after 2 days provided there is no other disqualifying condition.	✘- Must not drive for at least 2 weeks but need not notify DVLA. Driving may resume after 2 weeks provided there is no other disqualifying condition and LVEF at least 40%.

Pacemaker implant – including box change

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive for at least 1 week after pacemaker implant and pacemaker box change. Must notify DVLA of pacemaker implantation. Need not notify DVLA of pacemaker box change. Driving may resume after 1 week provided there is no other disqualifying condition.	✘- Must not drive for at least 6 weeks and must notify DVLA. Must notify DVLA of pacemaker implantation. Need not notify DVLA of pacemaker box change. Driving may resume after 6 weeks provided there is no other disqualifying condition.

Congenital complete heart block

	Group 1 car and motorcycle	Group 2 bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently until pacemaker implanted.
Symptomatic	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until pacemaker implanted.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently until pacemaker implanted.

Implantable cardioverter defibrillator (ICD)

Group 1 car and lorry drivers

In all cases of ICD implanted for sustained ventricular arrhythmia associated with incapacity, driving must stop for 6 months from the date of ICD implantation and any resumption requires:

the device being under regular review with interrogation
no other disqualifying condition
all the requirements as below must be met

Group 2 bus and lorry drivers

ICD implantation is a permanent bar to Group 2 licensing. In all cases of ICD implantation (including prophylactic ICD implantation) driving must stop permanently and:

DVLA must be notified
the licence will be refused or revoked permanently

ICD implanted for sustained ventricular arrhythmia associated with incapacity

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Without further sequelae	✘- Must not drive and must notify DVLA. Driving may resume after 6 months following implantation – except that any of the sequelae 1-4 below require further specific restrictions and may require notification to DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.
1. With any shock therapy, and/or anti-tachycardia pacing associated with incapacity or likely to cause incapacity (whether incapacity caused by device or arrhythmia)	✘- If therapy delivery was due to an inappropriate cause such as atrial fibrillation or programming issues driving may resume 1 month after complete control of any cause to the satisfaction of the cardiologist, and DVLA need not be notified. If therapy delivery was appropriate due to sustained ventricular tachycardia or ventricular fibrillation, DVLA must be notified and driving may resume 6 months after the event provided: ■ preventive steps against recurrence have been taken with anti-arrhythmic drugs, an ablation procedure, or ICD programming alteration and ■ there is an absence of further shock therapy and/or anti-tachycardia pacing associated with incapacity or likely to cause incapacity. Otherwise, must not drive for 2 years and must notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.
2. With any revision of electrodes or anti-arrhythmic drug treatment	✘- Must not drive for 1 month but need not notify DVLA. Driving may resume 1 month after electrode revision or drug alteration provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.
3. With defibrillator box change	✘- Must not drive for 1 week but need not notify DVLA. Driving may resume 1 week after box change provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.

ICD implanted for sustained ventricular arrhythmia not associated with incapacity

	Group 1 Car and motorcycle	Group 2 Bus and lorry
	! - Must not drive for 1 month following implantation and must notify DVLA. Driving may resume 1 month after implantation provided all of the following are met: ■ presentation was a ‘non-disqualifying’ cardiac event – i.e. haemodynamically stable sustained ventricular tachycardia without incapacity ■ LV ejection fraction is greater than 35% ■ any VT induced on electrophysiological study has RR interval greater than 250 milliseconds ■ during the post-implantation electrophysiological study, any induced VT could be pace-terminated by the ICD twice, without acceleration If any of the above not met, must not drive for 6 months following implantation. Note: should ICD subsequently deliver shock therapy and/or anti-tachycardia pacing associated with or likely to cause incapacity (except during normal clinical testing), DVLA must be notified and the relevant restrictions must be applied as detailed under the heading ICD implanted for sustained ventricular arrhythmia associated with incapacity).	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.

Prophylactic ICD

	Group 1 Car and motorcycle	Group 2 Bus and lorry
In asymptomatic individuals with a high risk of significant arrhythmia	✘- Must not drive for 1 month following implantation and must notify DVLA: ■ driving may resume 1 month after implantation if remains asymptomatic and no ICD therapy needed ■ should the ICD subsequently deliver shock therapy and/or anti-tachycardia pacing associated with or likely to cause incapacity (except during normal clinical testing), DVLA must be notified and relevant restrictions must be applied as detailed under the heading ‘ICD implanted for sustained ventricular arrhythmia associated with incapacity) For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently. For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Aortic aneurysm – ascending or descending thoracic and/or abdominal

All patients must have regular medical review.

Note: for Group 2 cases, the exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm.

	Group 1 car and motorcycle	Group 2 bus and lorry
Aortic aneurysm (see separate standards for people with bicuspid aortopathy or Marfan’s syndrome)	! - May drive and need not notify DVLA if aneurysm diameter is less than 6 cm and there is no other disqualifying condition.	! - May drive if the aneurysm diameter is 5.5 cm or less and there is no other disqualifying condition. Must notify DVLA.*
	! - May drive but must notify DVLA if aneurysm diameter is between 6 cm and 6.4 cm. May be relicensed/licensed subject to annual review of licence and there is no other disqualifying condition.	✘- Must not drive and must notify DVLA if the aneurysm diameter is greater than 5.5 cm. Licence will be refused or revoked. May be relicensed/licensed after successful surgical or interventional treatment if no aortic segment is greater than 5.5cm in diameter and there is no other disqualifying condition.*
	✘- Must not drive and must notify DVLA if aneurysm diameter is 6.5 cm or greater. Licence will be refused or revoked. May be relicensed/licensed after successful surgical or interventional treatment if no aortic segment is greater than 6.4 cm diameter and there is no other disqualifying condition.

*The exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm.

Bicuspid aortopathy

Note: Assess risk factors for aortic dissection for all drivers with bicuspid aortopathy*

Group 1 car and motorcycle

Group 2 bus and lorry

! - May drive and need not notify DVLA if the ascending aortic diameter is less than 5.5cm (or 5.0cm with a risk factor for aortic dissection *) and there is no other disqualifying condition.

! - May drive but must notify DVLA if ascending aortic diameter is 5.5-6.4cm or greater (5.0-5.9 cm or greater with a risk factor for aortic dissection *) and there is no other disqualifying condition.

! - May be relicensed subject to annual review of licence and if there is no other disqualifying condition.

! - May drive and need not notify DVLA if the ascending aortic diameter is less than 4.0 cm and there is no other disqualifying condition.

! - May drive but must notify DVLA if the ascending aortic diameter is 4.0-5.5cm (4.0-5.0cm with a risk factor for aortic dissection *) and there is no other disqualifying condition.

! - May be relicensed/licensed subject to annual review of licence and if there is no other disqualifying condition.

✘- Must not drive and must notify DVLA if ascending aortic diameter is 6.5cm or greater (6.0cm or greater with a risk factor for aortic dissection *).

Licence will be refused or revoked.

May be relicensed/licensed after successful surgical treatment without evidence of further enlargement and if there is no other disqualifying condition.

✘- Must not drive and must notify DVLA if ascending aortic diameter is 5.5cm or greater (5.0cm or greater with a risk factor for aortic dissection *).

Licence will be refused or revoked.

May be relicensed/licensed after successful surgical treatment without evidence of further enlargement and if there is no other disqualifying condition.

*Risk factors for dissection include:

Coarctation of aorta
Systemic hypertension
Family history of dissection
Documented increase in aortic diameter greater than 3mm/year

Aortic dissection

Note: ‘satisfactory control of blood pressure’ means clinically relevant to aortic dissection, not the DVLA standard for hypertension.

	Group 1 car and motorcycle	Group 2 bus and lorry
Type A	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after successful surgical treatment if: ■ aortic diameter including the false lumen is less than 6 cm ■ satisfactory control of blood pressure and treatment adherence ■ satisfactory medical follow-up ■ no other disqualifying condition	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after successful surgical treatment if: ■ maximum transverse diameter of the aorta at any location is less than 5.5cm (including the false lumen) ■ complete thrombosis of the false lumen ■ satisfactory control of blood pressure and treatment adherence ■ satisfactory medical follow up ■ no other disqualifying condition
Type B	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed only after successful surgical or interventional treatment, or with medical treatment if: ■ aortic diameter (including the false lumen) at any location is 6.0cm or less ■ satisfactory control of blood pressure and treatment adherence ■ satisfactory medical follow-up ■ no other disqualifying condition	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed only after successful surgical or interventional treatment, or with medical treatment if: ■ aortic diameter (including the false lumen) at any location is 5.5cm or less ■ complete thrombosis of the false lumen ■ satisfactory control of blood pressure and treatment adherence ■ satisfactory medical follow up ■ no other disqualifying condition

Marfan syndrome and other inherited aortopathies

Note: Assess risk factors for aortic dissection for all drivers with Marfan syndrome*

	Group 1 car and motorcycle	Group 2 bus and lorry
Marfan Syndrome without risk factors*	✓- May drive and need not notify DVLA if no aneurysm. ✘- If there is an aortic aneurysm must notify DVLA and must not drive if the aortic diameter exceeds 5cm.	! - Must notify DVLA. Must not drive if: ■ maximum aortic diameter is greater than 5 cm ■ severe aortic regurgitation ■ any other disqualifying condition Licence will be revoked/refused.
Marfan Syndrome with risk factors*	✓- May drive and need not notify DVLA if no aneurysm. ✘- If there is an aortic aneurysm must notify DVLA and must not drive if the aortic diameter exceeds 4.5cm.	✘- Must notify DVLA. Must not drive if: ■ maximum aortic diameter is greater than 4.5 cm ■ severe aortic regurgitation ■ any other disqualifying condition Licence will be revoked/refused.
Marfan Syndrome and aortic surgery	Driving may resume after successful surgical treatment (whether emergency or elective repair) and there is no other disqualifying condition.	✘- Debarred if emergency aortic surgery. Elective aortic surgery – individual assessment (see Appendix C for full details).
Other inherited aortopathies (for example, Loeys-Dietz syndrome, vascular type IV Ehlers-Danlos syndrome)	✓- May drive and need not notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Driving may resume if individual specialist assessment is favourable.

*Risk factors include:

Family history of aortic dissection
Severe aortic or mitral regurgitation
Greater than 3mm per year increase than aneurysm diameter
Pregnancy

Peripheral arterial disease

	Group 1 car and motorcycle	Group 2 bus and lorry
	✓ - May drive and need not notify DVLA. There must be no other disqualifying condition.	! - May drive but must notify DVLA. May be relicensed/licensed only if: ■ there is no symptomatic myocardial ischemia, and ■ the exercise or other functional test requirements can be met (see Appendix C).

Hypertension

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - May drive and need not notify DVLA, except: ✘- Must not drive if diagnosed with malignant hypertension until condition has been effectively treated or controlled but need not notify DVLA. (Malignant hypertension: elevation in systolic blood pressure greater than or equal to 180 mmHg or diastolic blood pressure greater than or equal to 110 mmHg associated with evidence of progressive organ damage.)	! - May drive and need not notify DVLA, except: ✘- Must not drive and must notify DVLA if resting BP is consistently: ■ 180 mm Hg or higher systolic and/or ■ 100 mm Hg or more diastolic ■ or if diagnosed with malignant hypertension May be relicensed/licensed after BP is controlled, provided there are no side-effects from treatment that affect or are likely to affect safe driving.

Cardiomyopathies

Note: DVLA bars Group 2 bus and lorry licensing when left ventricular ejection fraction is less than 40%.

Also refer to the following sections in this document:

arrhythmia
pacemaker implant
implantable cardioverter defibrillator
the European Society of Cardiology HCM Risk of Sudden Cardiac Death Calculator in Appendix C

Hypertrophic cardiomyopathy (HCM)

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. Must not drive if in the High Risk group (as per ESC HCM Risk-SCD calculator - see Appendix C for details) and/or if ICD is indicated/implanted. Licence will be refused/revoked. If in the Low Risk or Intermediate Risk group licensing will be permitted if the applicant is able to complete the full 9 minutes of the standard exercise tolerance test (or energy equivalent using a cycle ergometer) (see Appendix C for details). Should the applicant be unable to exercise for non-cardiovascular reasons cardiac MRI imaging must not reveal more than 15% of ventricular myocardium demonstrating gadolinium enhancement.
Symptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition (must meet all other relevant standards, eg angina, arrhythmia).	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing will be considered once symptoms are satisfactorily controlled and the criteria for asymptomatic HCM met as detailed above. If there is a history of associated syncope the standards for syncope need to be met in addition.

Dilated cardiomyopathy

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	! - May drive but must notify DVLA. LV ejection fraction must be at least 40% and there must be no other disqualifying condition.
Symptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence may be issued/renewed once asymptomatic, if LV ejection fraction is at least 40% and there is no other disqualifying condition.

Arrhythmogenic right ventricular cardiomyopathy and allied disorders

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA.	✘- Must not drive and must notify DVLA. May be relicensed/licensed following specialist electrophysiological assessment, provided there is no other disqualifying condition.
Symptomatic	✘- Must not drive and must notify DVLA if arrhythmia has caused or is likely to cause incapacity. May be relicensed/licensed once arrhythmia is controlled, provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing may be permitted if: ■ the applicant is on treatment ■ the applicant has remained asymptomatic for a period of 1 year and ■ the applicant remains under regular specialist electrophysiological review A 1-3 year licence may be considered if the specialist electrophysiological review is satisfactory. For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Heart failure

Refer to NYHA classification detailed below.

	Group 1 car and motorcycle	Group 2 bus and lorry
Asymptomatic NYHA Class 1	✓- May drive and need not notify DVLA.	! - May drive if LV ejection fraction is at least 40% but must notify DVLA.
Symptomatic
- NYHA class II	! - May drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving but need not notify DVLA.	! - May drive if left ventricular ejection fraction is at least 40%, symptoms are stable and not likely to distract the driver or otherwise affect safe driving but must notify DVLA.
- NYHA class III	! - May drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving but need not notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing can only be considered if symptoms controlled and in NYHA 1 or II, and left ventricular ejection fraction is at least 40%.
- NYHA class IV	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing can only be considered if symptoms controlled and in NYHA 1, II or III.	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing can only be considered if symptoms controlled and in NYHA 1 or II, and left ventricular ejection fraction is at least 40%. Depending on the likely cause for heart failure, exercise or other functional testing may be required irrespective of the NYHA class (see Appendix C).
Left ventricular assist device implanted	✘- Must not drive and must notify DVLA. Driving may be relicensed under individual assessment only after 3 months from implantation.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.

New York Heart Association (NYHA) classification of heart failure

The New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure (1):

class I no limitation of physical activity – ordinary physical activity does not cause fatigue, breathlessness or palpitation (includes asymptomatic left ventricular dysfunction)
class II slight limitation of physical activity – patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angina pectoris (symptomatically ‘mild’ heart failure)
class III marked limitation of physical activity – although patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically ‘moderate’ heart failure)
class IV inability to carry out any physical activity without discomfort – symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically ‘severe’ heart failure)

Cardiac resynchronisation therapy (CRT)

	Group 1 car and motorcycle	Group 2 bus and lorry
CRT pacemaker	✘- Must not drive for 1 week and must notify DVLA. Driving may resume after at least 1 week following implantation if: ■ there are no symptoms likely to affect safe driving ■ there is no other disqualifying condition	✘- Must not drive and must notify DVLA. Driving may resume after at least 6 weeks following implantation if: ■ LV ejection fraction is at least 40% ■ the requirements under heart failure section (see above) are met ■ there is no other disqualifying condition
CRT defibrillator	! - May drive subject to following provisions being met but must notify DVLA. Provisions: ■ the requirements under implantable cardioverter defibrillator (ICD) are met ■ there is no other disqualifying condition	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.

Heart transplant – including heart and lung transplant

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive for at least 6 weeks after surgery. Need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive for at least 3 months following surgery and must notify DVLA. May be relicensed after 3 months provided: ■ remains asymptomatic ■ the requirements for exercise or other functional tests can be met (see Appendix C) - annual testing is required ■ LV ejection fraction at least 40% ■ there is no other disqualifying condition

Pulmonary arterial hypertension (including chronic thromboembolic pulmonary hypertension) – an established diagnosis (under the care of a specialist centre)

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - Must notify DVLA. Low, intermediate risk category May drive provided no other disqualifying condition. Review 3 year licence to be issued. High risk category May drive provided satisfactory specialist assessment and the risk of a sudden and disabling event is deemed to be less than 20% per annum; there should be no other disqualifying condition and syncope standards need to be met. Review 1 year licence to be issued. Classification of low, intermediate or high risk categories as per 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Specialist assessment report will be needed for the above risk assessment.	✘- Must not drive and must notify DVLA. Low risk category Driving may be allowed provided satisfactory specialist assessment and the risk of a sudden and disabling event is deemed to be less than 2% per annum; there should be no other disqualifying condition and syncope standards need to be met. Review 1 year licence will be issued. Intermediate, high risk category Licence will be refused or revoked. Classification of low, intermediate or high risk categories as per 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Specialist assessment report will be needed for the above risk assessment.

Heart valve disease

Note:

also refer to heart valve surgery
separate standards for aortic stenosis, see below.

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.
Symptomatic (please refer to heart failure standards if relevant)	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. Relicensing considered once asymptomatic and no other disqualifying condition. If there is cerebral embolism, relicensing may be considered after 12 months following cardiological assessment.

Aortic stenosis (to include sub-aortic and supra-aortic stenosis)

See Appendix C for the definition of ‘severe’ asymptomatic aortic stenosis.

	Group 1 car and motorcycle	Group 2 bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA.	! - If mild to moderate aortic stenosis, may drive and need not notify DVLA. Moderate aortic stenosis must be under regular medical review DVLA must be notified if this progresses to severe aortic stenosis. ✘- If severe aortic stenosis, must not drive and must notify DVLA. An annual review licence may be issued, provided: ■ DVLA exercise tolerance test requirements are met (see Appendix C) ■ there is satisfactory medical follow-up Licensing will be refused if: ■ during an exercise test symptoms develop, blood pressure falls or there is sustained arrhythmia ■ a cardiologist considers that exercise testing would be unsafe for the individual ■ a test is not possible for any other reason
Symptomatic	✘- Must not drive and must notify DVLA. Licence will be refused or revoked pending assessment and treatment.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked pending assessment and treatment.

Heart valve surgery – including transcatheter aortic valve implantation and other cardiac or pulmonary percutaneous devices

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive for 4 weeks but need not notify DVLA. Driving may resume only after 4 weeks, provided there is no other disqualifying condition.	✘- Must not drive for 3 months and must notify DVLA. May be relicensed/licensed only after 3 months, provided: ■ no evidence of significant left ventricular impairment – that is, LV ejection fraction at least 40% ■ no ongoing symptoms ■ no other disqualifying condition

Congenital heart disease (CHD)

	Group 1 car and motorcycle	Group 2 bus and lorry
Asymptomatic	! - May drive and need not notify DVLA if asymptomatic and does not fall under any other category which requires notification to DVLA.	! - May drive, but must notify DVLA. Licence will be refused or revoked if CHD is severe. * Otherwise, DVLA may issue a licence for medical review at 1, 2 or 3 years, depending on specialist assessment and provided there is: ■ mild/moderate disease * ■ successful cardiac or pulmonary intervention (percutaneous device or surgery) ■ no other disqualifying condition
Symptomatic	✘- Must not drive and must notify DVLA. Symptoms include angina, palpitations, dyspnoea, symptoms related to uncontrolled hypertension, heart failure, heart valve disease. For patients with congenital heart disease who have had ablation, pacemaker including CRT, ICD, heart valve intervention (surgical or percutaneous) or percutaneous cardiac/pulmonary devices (ASD/VSD/coarctation/MAPCAs/pulmonary-systemic shunts etc) - if symptoms develop after being asymptomatic or if they fall under any other category which requires notification to DVLA, must notify DVLA. Individual assessment of symptomatic cases. DVLA may require specialist assessment to issue a licence, which may be subject to medical review at 1, 2 or 3 years. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked if CHD is severe. * Otherwise, following individual assessment of cases, DVLA may issue a licence subject to medical review at 1, 2 or 3 years, depending on specialist assessment and provided there is: ■ mild/moderate disease * ■ successful cardiac or pulmonary intervention (percutaneous device or surgery) ■ no other disqualifying condition

*See classification of congenital heart disease complexity and the section in Appendix C.

For syncope, refer to Chapter 1.

Transient loss of consciousness

ECG abnormality – suspected myocardial infarction

	Group 1 car and motorcycle	Group 2 bus and lorry
	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. May be relicensed/licensed, provided: ■ exercise or other functional test requirements from DVLA are met (see Appendix C) ■ there is no other disqualifying condition

Left bundle branch block

	Group 1 car and motorcycle	Group 2 bus and lorry
	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	! - May drive but must notify DVLA. May be relicensed/licensed if: ■ myocardial perfusion scan or stress echocardiography requirements from DVLA are met (see Appendix C) ■ there is no other disqualifying condition

Pre-excitation

	Group 1 car and motorcycle	Group 2 bus and lorry
	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	! - May drive and need not notify DVLA, except: If associated with arrhythmia must meet the relevant requirements (see arrhythmias) There must be no other disqualifying condition.

Long QT syndrome - all cases of Long QT syndrome must notify DVLA

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘ - Must not drive if history of syncope or Torsades de pointes or QTc* greater than 500ms and must notify DVLA. Licence will be refused/revoked. Relicensing will be considered upon appropriate specialist cardiologist assessment and standards of syncope met.	✘ - Must not drive if symptomatic or history of syncope or Torsades de pointes or QTc* greater than 500ms and must notify DVLA. Licence will be refused/revoked. Relicensing may be considered once asymptomatic and upon appropriate specialist cardiologist assessment and standards of syncope met.

* corrected QT interval

Brugada syndrome - all cases of Brugada syndrome must notify DVLA

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive if history of syncope possibly associated to Brugada syndrome or history of sudden aborted cardiac death and must notify DVLA. Licence will be refused/revoked. Relicensing will be considered upon appropriate specialist cardiologist assessment.	✘ - Must not drive if symptomatic or history of syncope possibly associated to Brugada syndrome or history of sudden aborted cardiac death and must notify DVLA. Licence will be refused/revoked permanently if history of syncope possibly associated to Brugada syndrome or history of sudden aborted cardiac death. Otherwise, relicensing may be considered once asymptomatic and upon appropriate specialist cardiologist assessment and standards of syncope met.

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Cardiovascular disorders: assessing fitness to drive

Angina - to include INOCA (ischaemia with non-obstructive arteries)

Acute coronary syndrome (ACS) - to include type 1 and type 2 myocardial infarction, MINOCA (myocardial infarction with non-obstructive coronary arteries) and Takotsubo cardiomyopathy

Elective percutaneous coronary intervention (PCI)

Coronary artery bypass graft (CABG)

Coronary artery disease

Spontaneous coronary artery dissection (SCAD)

Arrhythmias

Successful catheter ablation

Pacemaker implant – including box change

Congenital complete heart block

Implantable cardioverter defibrillator (ICD)

Group 1 car and lorry drivers

Group 2 bus and lorry drivers

ICD implanted for sustained ventricular arrhythmia associated with incapacity

ICD implanted for sustained ventricular arrhythmia not associated with incapacity

Prophylactic ICD

Aortic aneurysm – ascending or descending thoracic and/or abdominal

Bicuspid aortopathy

Aortic dissection

Marfan syndrome and other inherited aortopathies

Peripheral arterial disease

Hypertension

Cardiomyopathies

Hypertrophic cardiomyopathy (HCM)

Dilated cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy and allied disorders

Heart failure

New York Heart Association (NYHA) classification of heart failure

Cardiac resynchronisation therapy (CRT)

Heart transplant – including heart and lung transplant

Pulmonary arterial hypertension (including chronic thromboembolic pulmonary hypertension) – an established diagnosis (under the care of a specialist centre)

Heart valve disease

Aortic stenosis (to include sub-aortic and supra-aortic stenosis)

Heart valve surgery – including transcatheter aortic valve implantation and other cardiac or pulmonary percutaneous devices

Congenital heart disease (CHD)

ECG abnormality – suspected myocardial infarction

Left bundle branch block

Pre-excitation

Long QT syndrome - all cases of Long QT syndrome must notify DVLA

Brugada syndrome - all cases of Brugada syndrome must notify DVLA

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